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A seven-month-old with chronic intermittent biphasic stridor
A Tsagkovits1, A Hariri1, S Bhalla1
1St Mary's Hospital, London, UK.
Annals of the Royal College of Surgeons of England
|April 23, 2020
Summary
A rare cause of chronic paediatric stridor in a 7-month-old boy was an embedded pistachio shell in the esophagus. Prompt diagnosis and removal led to an uneventful recovery, highlighting the need for broader differential diagnoses.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Pulmonology
- Pediatric Gastroenterology
Background:
- Paediatric stridor, a high-pitched noisy sound during breathing, necessitates urgent evaluation due to potential serious underlying pathologies.
- Common causes include congenital conditions like laryngomalacia and acquired issues such as aerodigestive tract foreign bodies.
- Chronic stridor presentations require thorough investigation to identify the precise etiology.
Observation:
- A 7-month-old male infant presented with a 5-month history of chronic, intermittent, biphasic stridor.
- Initial diagnostic microlaryngoscopy and bronchoscopy identified localized tracheomalacia.
- Subsequent chest computed tomography (CT) revealed an unexpected esophageal foreign body.
Findings:
- The esophageal foreign body was identified as an embedded pistachio shell.
- Immediate rigid esophagoscopy successfully removed the foreign body.
- The infant experienced an uncomplicated recovery post-intervention.
Implications:
- Esophageal foreign bodies, though common in children, rarely present solely with stridor without overt digestive symptoms.
- Otolaryngologists should consider esophageal foreign bodies in the differential diagnosis of pediatric stridor, especially with atypical presentations.
- This case underscores the importance of comprehensive diagnostic workup for persistent pediatric stridor, even when initial findings suggest other conditions.
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